Cost analysis of three anesthetic regimens under auditory evoked potentials monitoring in gynecologic laparoscopic surgery.

ABSTRACT

BACKGROUND: Cost analyses of different anesthetic techniques have not been investigated in Taiwan. We compared propofol-based total intravenous anesthesia (TIVA), sevoflurane (SEVO) and desflurane (DES) anesthesias for cost and outcome under A-line auditory evoked potentials (AEP) monitoring. METHODS: We studied 90 consecutive female patients (ASAI-II) scheduled to undergo elective gynecologic laparoscopic surgery. The study was prospective, randomized, and single-blind in design. All patients were randomly divided into 3 groups i.e. groups TIVA, SEVO and DES. The A-line auditory evoked potential index (AAI) was maintained between 15-25. At the start of skin closure, the applied anesthetic was discontinued, and time of recovery from anesthesia was thenceforth reckoned until spontaneous opening of eyes and extubation. The costs of drugs were counted in New Taiwan (NT) dollars. RESULTS: The total cost was significantly higher in the SEVO and DES groups than in the TIVA group (NT 1,243, 1028, and 889, respectively) (P < 0.001). In addition, the cost of the principal anesthetic drug was significantly higher in the SEVO than in the DES and TIVA groups (NT 756, 530, and 468, respectively) (P < 0.01). Faster recovery was seen in the TIVA group than in the DES group and SEVO group (8.2, 13.7, 16.2 min, respectively) (P < 0.001). Incidences of postoperative nausea, vomiting, and pain were not significantly different among 3 groups. CONCLUSIONS: The cost of TIVA with propofol was less than SEVO or DES anesthesia and moreover, propofol TIVA offered benefit of faster recovery in our study.